Rapid Sequence

Complications and critical incidents arising during anaesthesia due to patient, surgical or anaesthetic factors, may cause harm themselves or progress to more severe events, including cardiac arrest or death. As part of the 7th National Audit Project of the Royal College of Anaesthetists, the authors studied a prospective national cohort of unselected patients . Anaesthetists recorded anonymous de...

There are two papers we are discussing today and they are the first in a series of results from probably the most important piece of peri-operative research from 2023 – NAP7! The first paper reports results from the local coordinator baseline survey. The second paper then looks at preparedness for and experiences of peri-operative cardiac arrest. The papers are rich with data and this interview ai...

Today we are going to be talking about the December 2023 issue , which is online today! This issue is really exciting because it is the first to contain papers reporting results from NAP7. This will all be dealt with separately, so instead we are going to focus on other papers in the issue. And there is a lot to choose from: prehabilitation; pain assessment; dexmedetomidine; and dexamethasone. Joi...

This month, we discuss three important papers from the November 2023 issue with Professor Ed Mariano. A great way to get all your CPD for the month in just half an hour! 1. Is the future of nitrous oxide as volatile as the gas itself?  https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16086 2. PROSPECT methodology for developing procedure-specific pain manage...

This month, we spoke with @GongGasGirl about her time at Annual Congress 2023, conferencing, whether or not desflurane should be banned, changes in trends on social media and MR opioids. The October issue is available now and contains lots of great papers with clinically relevant content. Enjoy!

Point-of-care gastric sonography offers an objective approach to assessing individual pulmonary aspiration risk before induction of general anaesthesia. This new paper aimed to evaluate the potential impact of routine pre-operative gastric ultrasound on peri-operative management in a cohort of adult patients undergoing elective or emergency surgery at a single centre. For this new podcast, Dr Eime...

Despite concerns and recommendations, modified-release opioids are still commonly used for the management of acute pain following total hip and knee arthroplasty. There is a need to compare modified-release and immediate-release opioid use following these procedures, and to determine whether the use of modified-release opioids is safe or harmful. The primary objective of this study was to examine...

Neuraxial labour analgesia is a safe and effective method of pain relief. Following initiation of analgesia with epidural or combined spinal-epidural, this can be maintained with continuous epidural infusion, manual intermittent boluses, patient-controlled epidural analgesia (PCEA), programmed intermittent epidural bolus (PIEB) or a combination of these. This new RCT finds that a PCEA high-volume...

Guidance for the timing of surgery following SARS-CoV-2 infection needed reassessment given widespread vaccination, less virulent variants, contemporary evidence and a need to increase access to safe surgery. This is the third iteration of consensus guidance around timing of surgery and risk assessment . Find out here why the update was required and what is new for 2023.

This new meta-analysis from Hansel et al. is a must read for all . Join Associate Editor Susannah Patey as she speaks with the authors about the key findings and clinical conclusions. 

The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. This new study compares their use for elderly patients undergoing low risk surgery with a composite of postoperative pulmonary complications as the primary outcome.  It is a fascinating trial for many reasons and we expect there will be much discussion amongst anae...

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. This new paper utilised the OpenSAFELY database to look at practices and outcomes in England, and suggests that some patients can be safely operated within 2 weeks from infection. This podcast goes deeper into the associated issues...

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3–4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering a...

This new paper from the AERATOR group examines the science around aerosol generation and awake tracheal intubation (ATI). Their study was performed on a single day during an ATI course on 12 anaesthetic trainees. They show that ATI without sedation generates high concentrations of respiratory aerosol. Professor Ross Hofmeyr talks to the authors about their study, its clinical implications and what...

We caught up with Dr Fiona Kelly, lead author of a new guideline from the Association of Anaesthetists and the Difficult Airway Society on human factors in anaesthesia. The guideline and  narrative review were published and launched live at the Winter Scientific Meeting in London today and there are several actions that we can all take today to impact patient care.  Time to place less reliance on...

Pre-operative anaemia is common in patients undergoing non-cardiac surgery and associated with an increased risk of blood transfusion, hospital length of stay and postoperative complications. This podcast is all about a new secondary analysis of the PREVENTT study. We are delighted to be joined in Australia by three of the papers authors, Professor Toby Richards , Dr Anastazia Keegan and Professor...

Today, we were joined by three authors ( Dr Alopi Patel , Dr Michelle Kars and Prof Ed Mariano ) of a new paper which is all about how to use social media to get published . This forms part of a new series of articles called Reviewer Recommendations, which is very much a ‘how to’ guide for authors and readers. Enjoy!

Today we will be discussing this new paper which describes and validates a new anaesthetic complexity score, which is is a clinician-designed, real-world tested model of case complexity in anaesthetics. It is inclusive of, but distinct from, patient and surgical risk.  The paper is of interest because of the methods used and also the potential implications for increasing efficiency and productivit...

The Editors of Anaesthesia acknowledge the EDI problems we face in anaesthesia and medicine as a whole. Without taking action to address these problems, these issues will persist. This newly published position statement is from the Editors of Anaesthesia, including the Editor-in-Chief. For this podcast, the principal authors join Association of Anaesthetists CEO Nicky de Beer to discuss why and ho...

Climate change is a real and accelerating existential danger. Urgent action is required to halt its progression, and everyone can contribute. Pollution mitigation represents an important opportunity for much needed leadership from the health community, addressing a threat that will directly and seriously impact the health and well-being of current and future generations. Inhalational anaesthetics...

There is very limited evidence about the relative effectiveness of emergency surgery vs. non-emergency surgery strategies for patients with common acute conditions. This lack of evidence means that there is likely to be considerable practice variation in the NHS in England. The ESORT study , which was published last night, aimed to compare the effectiveness of emergency surgery or not for five acu...

This new guideline provides an update to the previously published consensus statement on SARS-CoV-2 infection, COVID-19 and timing of elective surgery to assist policymakers, administrative staff, clinicians and patients . It focuses on the omicron variant, which is now strongly dominant in many countries. However, the principles may also be of relevance to future variants. To set the paper in its...

Joining us today we have the authors of a new paper reporting the effect of a text message intervention on burnout in trainee anaesthetists. First we have Emily Larson who is a Senior Advisor at The Behavioural Insights Team. Emily has worked on reducing burnout and increasing wellbeing with physicians, educators and children. We also have Dr Alix Brazier who is also a Senior Advisor at The Behavi...

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful. This new national survey is all about recruitment to higher specialty training in anaesthesia in the UK during the COVID-19 pandemic . Joining Dr C Hughes was Dr C Holt, Dr J Subramaniam, Dr N Durrant and Dr S Ed...

What better way to see in any new year than with a brand-new Anaesthesia Special Supplement! This year, it is all about the peri-operative and critical care management of the brain, which has been guest edited by Dr Jugdeep Dhesi and Professor Alana Flexman. Joining us also were journal Editors Professor Iain Moppett and Dr Matt Wiles. Topics include: Chronic SDH Peri-operative neurocognitive diso...